Diagnosis and management of a rare paratesticular venous malformation in a pediatric patient

A 14-year-old presented with an asymptomatic left testicular mass after a brief episode of pain. Examination showed a non-tender left testis that was significantly larger than the right. Ultrasound revealed a 4.5-cm avascular mass and an absence of normal testicular parenchyma. Tumor markers were unremarkable. A CT scan demonstrated no lymphadenopathy but identified a prominent left spermatic cord. Due to a suspicion of chronic torsion vs. malignancy, a left radical orchiectomy was performed. Pathology identified a hemorrhagic paratesticular venous malformation without signs of germ cell neoplasia, a rare entity.